Resilient and Sustainable Systems for Health

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  • An effective health system is key to improving health and mitigating health-related financial risks. From the creation of the Global Fund, there was a recognition that strong health systems integrating robust community responses were essential to effectively fight HIV, TB and malaria. Retaining attention and commitment to investing in systems is essential to build on gains of the Millennium Development Goals in order to effectively progress towards the new set of Sustainable Development Goals.

  • The Ebola crisis in West Africa was a wake-up call – a stark reminder that local health threats and weak health systems are global threats that can decimate economies and cause instability. The Ebola crisis also revealed unique problems in challenging operating environments and made poignant the need to understand health as part of a development continuum. This requires differentiated investments that respond to a country’s position on the continuum between challenging operating environment and self-sustaining state.

    Ending HIV, TB and malaria as epidemics can only be achieved with effective systems for health. The Global Fund partnership’s investments in HIV, TB, and malaria create substantial positive effects on the overall health systems of countries with serious burden of these diseases. This mutually-reinforcing relationship between funding for disease-control programs and funding for cross-cutting aspects of health systems is a cornerstone of the Global Fund’s approach. Overall, 40 percent of the Global Fund’s investments are made in health systems. These investments are delivered in three main ways: (1) support for programs to control HIV, TB and malaria, (2) specific health systems investments, and (3) innovative mechanisms and policies that leverage further support for health systems from both domestic sources and other partners.

    In 2015, the Global Fund prepared a report on this critically important issue: 

    Supporting Countries to Build Resilient and Sustainable Systems for Health: The Role of the Global Fund

  • Healing the Community

    Ethiopia’s population of 85 million people lives, for the most part, in small rural communities widely dispersed, making access to health care a significant challenge. In the last decade, however, the Ethiopian government has built or upgraded 15,000 health care facilities across the country and now more than 92 percent of the Ethiopian population lives within 10 kilometers of a public health care facility. The Ethiopian government also launched the Health Service Extension Program, through which 37,000 women have been trained to serve their communities as health extension workers.

  • Investing in Resilient and Sustainable Systems for Health

    Systems for health do not stop at a clinical facility but run deep into communities and can reach those who do not always go to health clinics, particularly the vulnerable and the marginalized. Systems for health involving the community will always be the first to identify, report and respond to emergency health threats. The Global Fund has identified the following priorities for supporting resilient and sustainable systems for health in the new strategy:

    • Support national health strategies and national strategic plans to control HIV, TB and malaria;
    • Focus on a person, not just a disease: support integrated service delivery;
    • Support specific aspects of a resilient health system central to the Global Fund’s mission and core competencies, such as procurement and supply chain management, quality assurance of programs through strong data management and human resources, and financial and risk management;
    • Capture and catalyse innovation from across all sectors to drive greater impact and value for money;
    • Promote and reinforce community responses and involve affected communities in national decision-making;
    • Support countries to leverage domestic and international financing for their systems for health;
    • Tailor investments to the unique stage a country is in along the development continuum, to its specific health system and to the unique constellation of partners in each nation.
  • While these actions can be a part of the strategy to fight a particular disease such as AIDS, TB or malaria, they also serve broader, system-wide objectives by:

    • Fostering synergies across disease programs, particularly in terms of integrated planning and service delivery
    • Enabling the health system to scale up essential health services
    • Supporting the engagement of communities, and reaching those most affected and most excluded
    • Making the health system more resilient and sustainable
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